1 Enhancing Comprehensive HIV Prevention Planning A Syndemic Spatial Analysis of HIV and STI Burden Mike Janson, MPH, Virginia Hu, MPH, Kai- Jen Cheng, Douglas Frye, MD, Peter Kerndt, MD, Jennifer Sayles, MD, MPH Los Angeles County Department of Public Health 2011 National HIV Prevention Conference August 16, 2011
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1 Enhancing Comprehensive HIV Prevention Planning A Syndemic Spatial Analysis of HIV and STI Burden Mike Janson, MPH, Virginia Hu, MPH, Kai-Jen Cheng,
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Enhancing Comprehensive HIV Prevention Planning
A Syndemic Spatial Analysis of HIV and STI Burden
Mike Janson, MPH, Virginia Hu, MPH, Kai-Jen Cheng, Douglas Frye, MD, Peter Kerndt, MD,
Jennifer Sayles, MD, MPH
Los Angeles County Department of Public Health
2011 National HIV Prevention Conference
August 16, 2011
California
2.6%
97.4%
Land Area (Square Miles)
Los Angeles County
Other California Counties
26.6%
73.4%
Population
Los Angeles County
Other California Counties
Los Angeles County
Los Angeles County California
9,848,011 36,961,664
Los Angeles County California
4,060 sq mi 155,959 sq mi
Los Angeles County California
Estimated living HIV/AIDS Cases 61,700 133,705*
Reported HIV/AIDS Cases 44,450 110,994
Data Source: U.S. Census , 2010
Data Source: Los Angeles County Department of Public Health, HIV Surveillance, 2011; California State Department of Public Health, State Surveillance Data, 2010
*133,705 calculated assuming 21% of HIV positive Californians are unaware of their status.
46.1%53.9%
HIV/AIDS Cases, 2010
Los Angeles County
Other California Counties
21.0%
40.0%
35.0%
3.0% 1.0%
HIV/AIDS Cases
Black
Latino
White
Asian/PI
NA/AI
8.8%
47.3%30.1%
13.3% 0.5%
Overall, Race/Ethnicity
Population Estimated HIV/AIDS Cases
9,848,011 61,700
Data Source: U.S. Department of Commerce, 2010; Los Angeles County Department of Public Health, HIV Surveillance, 2011
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Los Angeles County
Data Source: U.S. Census Bureau, Topologically Integrated Geographic Encoding and Referencing system, 2009. Maps Drawn at 1:750,000 scale.
Chicago
Houston
New York City
San Francisco
Philadelphia
District of Columbia
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LAC ECHPP Activities• Syndemic Planning
– Integrated use of HIV and STI surveillance data
• Identify optimal mix of HIV programming– Robust Decision Making to inform prioritization,
scale, and optimal mix of HIV prevention interventions for LAC
Where should we focus our prevention efforts to make the largest impact with resources we have?
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Syndemic Planning Model
• Focuses on connections among cofactors of disease– HIV– Syphilis– Gonorrhea
• Considers those connections when developing health policies
SPA 1: Antelope Valley
SPA 2: San Fernando
SPA 3: San Gabriel
SPA 5: West
SPA 7: East
SPA 8: South Bay
SPA 4: Metro
SPA 6: South
Service Planning Areas
(SPAs)
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SPA 8: South Bay
HIV Case Density, 2009, SPA 8Very Low Density
Very High Density
Source: 2009 New HIV Cases, HIV Epidemiology Program
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Long BeachRancho Palos Verdes
Cases per 2 Square Miles
<0.5
0.5 - 1.7
1.8 - 3.6
3.7 - 6.6
6.7 - 10.8
10.9 - 15.2
15.3 - 21.8
21.9 - 42.0
>42.0
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Spatial Analysis Background
• Services historically prioritized by Service Planning Area (SPA)
– Disease burden geographical differences are not explained by SPA boundaries
– The use of GIS allows for small-area analysis and spatial epidemiological techniques
– The sharing of HIV and STI surveillance data have allowed for a more accurate picture of overall the overall HIV/STI syndemic
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Data Sources• New HIV/STD Cases, 2009
– 2,036 HIV cases– 2,641 Syphilis cases
• 1,042 with HIV co-infection
– 7,918 Gonorrhea cases• 552 with HIV co-infection
• Case residence addresses were geocoded– Overall geocode match >92%
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Methodology• Are HIV/STI cases dispersed or clustered?
– Average Nearest Neighbor (ANN) statistic, (ArcGIS)
• Can patterns be grouped into manageable clusters?
2. de Smith, Michael J; Goodchild, Michael F; Longley, Paul A. Geospatial Analysis: A Comprehensive Guide to Principles, Techniques and Software Tools. 3rd Edition. UK: Splint Spatial Literacy in Teaching; 2011